Abstract
Background
Patient preferences have been shown to be associated with treatment effects (1) and recent national guidelines suggest using patient preferences to help inform clinical interventions (2).
Aim
To determine the treatment preferences of LBP patients and whether these affect clinical outcome.
Methods
Prospective cohort study of UK primary care LBP consulters (n=1591). Questionnaires were completed at baseline and 6 months including data on back pain and disability (Roland Morris Disability Questionnaire; RMDQ). Patients were asked “What treatment would you prefer to have for your back problem?” (response in free text, asked to indicate “none” if no preference).
Results
One third of patients (612/1591, 38%) expressed no treatment preference. Those who expressed preferences (696/1591, 44%) did so most often for physiotherapy or exercise (192/1591 12%), chiropractic (91/1591, 6%) or osteopathy (85/1591, 5%). Patients expressing treatment preferences were likely to be younger (median age 44 years vs. 46 years, p=0.0008) and employed (55% vs. 44%, p=0.036) than those with no preferences. No gender differences were observed. Expressing treatment preferences did not appear to affect the treatment that patients received, 58% received GP advice or medication, 18% physiotherapy, 5% chiropractic and 4% osteopathy. Treatment preferences were not associated with clinical outcome (RMDQ) at any follow-up.
Conclusions
A significant proportion of LBP patients do not express treatment preferences. Even those expressing preferences for exercise or manipulation were more likely to receive GP advice or medication. Therefore, using patient preferences to inform treatment may be difficult to implement in practice.
1 Preference Collaborative Review Group. Patients' preferences within randomised trials: systematic review and patient level meta-analysis. BMJ. 2008 Oct31;337:a1864. doi: 10.1136/bmj.a1864.CrossrefPubMed Google Scholar
2 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 88: Low back pain: early management of persistent non-specific low back pain. The National Collaborating Centre for Primary Care, May 2009, London, UK (www.nice.org.uk/CG88fullguideline). Google Scholar
Conflicts of interest: None
Sources of funding: Arthritis Research Campaign
This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting.
